Provider Demographics
NPI:1750935920
Name:VIBRANT LIFE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:VIBRANT LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PURTELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-379-2639
Mailing Address - Street 1:1956 S KOELLER ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-6153
Mailing Address - Country:US
Mailing Address - Phone:920-385-4073
Mailing Address - Fax:920-385-1594
Practice Address - Street 1:1956 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6153
Practice Address - Country:US
Practice Address - Phone:920-385-4073
Practice Address - Fax:920-385-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty